Precision of bilateral electrode implantation and treatment outcome in Parkinson's disease after subthalamic nucleus deep brain stimulation

Abstract

Objective To investigate whether there is a significant difference in the accuracy of the two-sided electrode implanted during the same period in Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS), and whether the accuracy affects the bilateral postoperative effects. Methods Twenty-nine PD patients admitted in our department from January 2016 to December 2018, who underwent bilateral STN-DBS surgery were re-examined with CT scanning on the head after bilateral electrodes were implanted during the operation. The results were merged with preoperative 3T-MRI images (with planned targets). The implanted electrodes were measured and calculated for error distance from the planned targets. Unified Parkinson's Disease Rating Scale Ⅲ (UPDRSⅢ) was used to evaluate the improvement of the symptoms before and in 6 months after operation. Pearson correlation analysis was used to study the correlation among age, gender, onset age and course of disease with improvement rate and deviation. Results Finally, 27 patients were enrolled, and 54 electrodes were implanted successfully. There were no significant differences in the age, gender, onset age and course of disease and the improvement rate and deviation among these patients (P>0.05). No obvious difference was seen in the mean deviation between the first implanted electrodes and second implanted electrodes (t=1.437, P>0.05). The symptoms of all patients were obviously improved. In 6 months after surgery, the average improvement rate of systemic symptoms was (78.10±10.25)% with drug on, and the average decrease of the equivalent dose of levodopa was 45.07%. The improvement rate was (83.15± 9.16)% for the first side, and (83.52±11.21)% for the second side. There was no significant difference in the improvement of limb symptoms between the 2 sides (P>0.05). Conclusion The accuracy of simultaneous implantation of bilateral electrodes in STN-DBS is not significantly different from that of the electrodes implanted sequentially, while still achieving good clinical outcomes.

Keywords

• parkinson's disease
• subthalamic nucleus
• deep brain stimulation
• simultaneous implantation
• treatment outcome